Pathology - Vulva Flashcards
What is the vulva defined as?
Area external to the hymen
What is a Bartholin cyst?
- Blockage of Bartholin gland causing accumulation of gland fluid
- Unilateral, painful cystic lesion
- Lower vestibule adjacent to vaginal canal
- Occurs in women of reproductive age
- Associated with infection
What is the colloquial name for condylomas?
Genital warts
Describe a condyloma
- Watery neoplasm of vulvar skin, often large
- Characterized by koilocytic change
- Rarely progresses to carcinoma
What are condylomas commonly due to?
HPV 6 or 11 (low risk for carcinoma)
What are the high risk strains of HPV?
16, 18 (mostly); 31, 33 (also)
What does a condyloma look like on histology?
Raisin-like appearance of nucleus
What is lichen sclerosis?
- Thinning of epidermis and fibrosis of dermis
- Leukoplakia (white patch) with parchment-like vulvar skin
- Benign - slight increased risk of sq cell carcinoma
Who is affected by lichen sclerosis?
Postmenopausal women
What is lichen simplex chronicus?
- Hyperplasia of vulvar sq epithelium
- leukoplakia w. thick, leathery vulvar skin
- Benign (no incr risk of SCC)
What can lichen simplex chronicus be due to?
- Chronic irritation / scratching
- Postmenopausal women
What does vulvar carcinoma present with?
Leukoplakia
- Biopsy required to distinguish from other causes
What are the 2 pathways associated with vulvar carcinoma?
- HPV related (younger 40-50) arises from vulvar intraepithelial neoplasia
- Non-HPV-> lichen sclerosis (older women >70) arises from chronic irritation
What is extramammary paget disease?
Malignant epithelial cell in the epidermis of the vulva
- Presents as erythematous, pruritic, ulcerated skin
- Carcinoma in situ - usually no underlying carcinoma
What is the differential diagnosis of extramammary Paget disease?
Melanoma
What are the differences between Paget cells and melanoma
Paget cells: PAS +, keratin + and S100-
Melanoma: PAS -, keratin - and S100+
What does PAS + indicate?
Mucus secreting
What does keratin + indicate?
Epithelial tissue (usually)
What is imperforate hymen?
- Incomplete degeneration of the central portion of the hymen
- Accumulation of vaginal mucus at birth -> self-resolving buldge in introitus
What does imperforate hymen present with?
- Primary amenorrhea
- Cyclic abdominal pain
- Hematocolpos (accumulation of menstrual blood in vagina)
- Buldging bluish hymenal membrane
